Evaluating Housing First in Amsterdam: The Discus Project


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Presentation given by Judith Woolf/Dorieka Wewerinke, UMC St Radboud at the FEANTSA/French Permanent Representation to the EU seminar, 'Housing First: A Key Element of European Homelessness Strategies', 23rd March 2012.

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Evaluating Housing First in Amsterdam: The Discus Project

  1. 1. Discus Amsterdam: Housing First Evaluation Dorieke Wewerinke Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” © UMC St Radboud Maart 2012 Judith Wolf, Marjolein Maas, Sara Al Shamma
  2. 2. Onderzoekscentrum maatschappelijke zorgContents• Discus Amsterdam: Housing First• Research objectives & study components• Discus clients: selection criteria• Profile of clients• Main outcomes: Onderzoekscentrum maatschappelijke zorg Health, social contacts, Quality of life, residential stability, rates of nuisance, “gedreven door kennis, bewogen door mensen” perceived benefits (satisfaction with Discus and QoL improvements), fulfilment of expectations• Policy implications• Future implementation
  3. 3. Onderzoekscentrum maatschappelijke zorgDiscus Amsterdam: Housing First (Pathways to Housing, Tsemberis, 1992)• Target group: roofless people• Independent accommodation (dependent rent contracts)• Housing accommodation dispersed throughout city• Rehabilitation approach: focus on individual strengths Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen”
  4. 4. Onderzoekscentrum maatschappelijke zorgSelection criteria for Discus Amsterdam: Housing First1. Be motivated2. Cause no nuisance3. Pay the rent4. Accept at least one home visit per week by the housing support worker Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen”5. Agree to income management6. Comply with the Discus behavioural rules
  5. 5. Onderzoekscentrum maatschappelijke zorgEvaluation: objectives and study components(Commissioned bij HVO Querido, City of Adam, Agis Health Insurance Company) Gain insight into: Study period: 010 2010 – 010 2011  Profile of participants  Health  One semi-structured, face-to-face interview with clients (use of  Social contacts standardized instruments)  Quality of life and QoL improvements  Completion of interview  Residential stability questionnaires by support workers Onderzoekscentrum maatschappelijke zorg  Rates of nuisance “gedreven door kennis, bewogen door mensen”  Perceived benefits from Discus:  Group interview with support workers - QoL improvements - Satisfaction with Discus  Analysis of nuisance data recorded by housing associations and DiscusNo conclusions can be drawn as to whether Discus is better than other types of housing provision.
  6. 6. Onderzoekscentrum maatschappelijke zorgProfile of Discus customers84 customers registered with Discus between Dec 2010 - Feb 2011;64 participants in study, response rate 80%  78% male, average age 45 (range: 24 to 62)  55% of ethnic minority background, 74% non-Western  41% primary or no education  80% unmarried  88% single  Onderzoekscentrum maatschappelijke zorg 48% had children, 65% had 1 or 2 children “gedreven door kennis, bewogen door mensen”  94% lived partly or wholly from social benefit, 72% from social assistance  41% were in paid employment or voluntary work  Average monthly disposable income: €208  70% in debt → €13,000 on average (range: €100 to €120,000)
  7. 7. Onderzoekscentrum maatschappelijke zorgHealth  Self-appraisal of physical and mental health: reasonable to excellent: 67% (physical), 80% (mental)  52% had physical health problems, 45% had long-term health problems, 45% were currently in treatment  Higher rates of mental health problems (anxiety, depression, psychosomatic symptoms, hostility) in comparison to Dutch general population  ≥ 50% reported past-month use of ≥ 5 daily units of alcohol, cannabis, crack or powder Onderzoekscentrum maatschappelijke zorg cocaine, or methadone / LAAM / buprenorphine door kennis, bewogen door mensen” “gedreven Indication of vulnerability: lifetime use of mental health services  52% outpatient addiction treatment  52% inpatient addiction treatment  64% outpatient psychiatric treatment  42% inpatient psychiatric treatment
  8. 8. Onderzoekscentrum maatschappelijke zorgSocial contactsVisits within personal network: Family: 40% at least once a week, 29% never Friends and acquaintances: 52% at least once a week, 24% never Loneliness Discus- Dutch customers population Not lonely 25% 68% Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” Average loneliness 47% 28% Rather lonely 23% 3% Extremely lonely 5% 1%
  9. 9. Onderzoekscentrum maatschappelijke zorgQuality of Life (scale 1-7: ‘terrible’ to ‘delighted’)General quality of life reported high: average score 5.0Highest satisfaction rates:Household maintenance and self-care: 5.7Sense of safety: 5.7Accommodation: 5.4Emotional health: 5.4Social functioning: 5.4 Onderzoekscentrum maatschappelijke zorgResilience: 5.4 “gedreven door kennis, bewogen door mensen”Relatively lower satisfaction:Finances: 4.4Relations with family: 4.6Relations with offspring: 4.0
  10. 10. Onderzoekscentrum maatschappelijke zorgResidential stabilityCustomers registered with Discus between inception in 2006 and 6 April 2011: n = 123Still housed with Discus Support:77% (n = 95)No longer participating:23% (n = 28) Onderzoekscentrum maatschappelijke zorg- 7 had independent rent contracts “gedreven door kennis, bewogen door mensen”- 10 transferred to different type of housing provision- 3 departed due to severe nuisance- 8 departed for other reasons: 3 died, 1 withdrew voluntarily, 1 returned to family abroad, 3 entered prison
  11. 11. Onderzoekscentrum maatschappelijke zorgRates of nuisance (2006-2011)Complaints to housing associations: 26 nuisance complaints for 100 flats Most complaints were by neighbourhood residents, most were about noise.Complaints to Discus: Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” 41 complaints, 75% involving mild to moderate nuisanceDiscus takes up the complaints, but precise outcomes are not always clear.Needs improvement.
  12. 12. Onderzoekscentrum maatschappelijke zorgPerceived benefits from Discus: QoL improvements General quality of life (N=63) Housing situation (N=63) Finances (N=63) Structured daily activities (N=63)Household maintenance and self-care (N=63) Relations with family (N=61) Social contacts (N=63) Sense of safety (N=63) Physical health (N=63) Onderzoekscentrum maatschappelijke zorg Mental health (N=63) “gedreven door kennis, bewogen door mensen” Substance use (N=62) Relations with offspring (N=21) Personal resilience (N=63) 0% 20% 40% 60% 80% 100% Better Unchanged Worse
  13. 13. Onderzoekscentrum maatschappelijke zorgPerceived benefits from Discus: SatisfactionSatisfaction: Average score: 8.2 (1-to-10 scale)69%: expectations fulfilled, satisfaction with outcome– ‘Things are going great.... I’m satisfied with my flat. Discus recognises myproblems and accepts me like I am.’– ‘I’ve improved 99 per cent. I hadn’t expected that.’19%: expectations partly fulfilled Onderzoekscentrum maatschappelijke zorg– ‘I’m much more independent. It’s succeeded halfway. I’m still in debt, “gedreven door kennis, bewogen door mensen”unemployed and not financially stable.’12%: expectations not fulfilled, outcome below expectations– ‘I’m disappointed. I’ve got no job. I believed that if I got a flat, I’d soon get a job,but things were different in practice. My social life is also not as good as I hadhoped.’
  14. 14. Onderzoekscentrum maatschappelijke zorgConclusions  Discus reaches a severely deprived group: people with weak socioeconomic status, multiple problems and high use of social and health services (past and present).  High satisfaction rate with Discus: a score of 8.2  High quality of life and high rates of perceived improvements in many life domains Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen”  Relatively low rates of nuisance complaints  After 5 1/2 years of Discus, the majority of clients (77%) were still housed with Discus support and the real dropout rate was low (2.4%).  Discus Amsterdam is successful!
  15. 15. Onderzoekscentrum maatschappelijke zorgPolicy implications Parties concerned (HVO Querido, municipality of Amsterdam, and a health insurance company) want to continue policy of extramuralisation Invest in Housing First: health insurance company already agreed on budget for 240 extra care packages for Housing First (commitment is 300 or more) Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” In collaboration with housing associations 240 houses have to be made available for Housing First (and possibly more).
  16. 16. Onderzoekscentrum maatschappelijke zorgFuture implementation Further development of strength based aproach, own direction and rehabilitation Continued investment in (new) workers; -recruiting and selecting workers with qualities needed to strengthen the team -keeping up with new knowledge and training Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” Focus on consensus within and between teams to assure internal quality Practice based learning: reflecting on practice, developing procedures and annually assessing necessary adjustments
  17. 17. Onderzoekscentrum maatschappelijke zorgThanks are due toCustomers of DiscusDiscus housing support workersMembers of the advisory committee:Wessel de Vries, Noor Bertens, Paul van Dijk and Nienke Boesveldt Onderzoekscentrum maatschappelijke zorgResearch team: “gedreven door kennis, bewogen door mensen”Sara Al Shamma, Marjolein Maas, Nicoline Jansen, Astrid Altena and Judith WolfInterviewers
  18. 18. Onderzoekscentrum maatschappelijke zorg Thank you for your attention. Any questions? Onderzoekscentrum maatschappelijke zorg “gedreven door kennis, bewogen door mensen” Discus: Wessel de Vries: discus@hvoquerido.nlUMC St Radboud: Judith Wolf: J.wolf@elg.umcn.nl